Prevention of infection by ciprofloxacin in neutropenia.
Ciprofloxacin with erythromycin, each at a dose of 250 mg 12-hourly, is effective prophylaxis against Gram-negative bacteraemia in neutropenic patients. The erythromycin component may contribute little to prophylaxis and does select for erythromycin-resistant viridans streptococci which then cause bacteraemia. Ciprofloxacin prophylaxis does not prevent coagulase-negative staphylococcal bacteraemia and resistant strains are selected. Initial use of vancomycin with a ureidopenicillin in pyrexial patients is currently justified by the exclusively Gram-positive nature of breakthrough bacteraemia. In patients failing to respond to this regimen, treatment modification to include full-dose amphotericin is frequently effective. Surveillance and containment isolation of patients carrying resistant Gram-negative species is prudent to prevent the spread of such resistant bacteria in oncology/haematology units.
Warren
R E
RE
Clinical Microbiology Laboratory, Addenbrooke's Hospital, Cambridge, UK.
Wimperis
J Z
JZ
Baglin
T P
TP
Constantine
C E
CE
Marcus
R
R
D002939:Ciprofloxacin / Q000627:therapeutic use*; D004917:Erythromycin / Q000627:therapeutic use*; D005243:Feces / Q000382:microbiology; D006090:Gram-Negative Bacteria; D006801:Humans; D009503:Neutropenia / Q000150:complications*; D018805:Sepsis / Q000517:prevention & control*; D013203:Staphylococcal Infections / Q000517:prevention & control*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
D002939:Ciprofloxacin; D004917:Erythromycin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination